US11076894B2 - System for inserting and removing a locator-pin in a bone - Google Patents

System for inserting and removing a locator-pin in a bone Download PDF

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Publication number
US11076894B2
US11076894B2 US15/631,081 US201715631081A US11076894B2 US 11076894 B2 US11076894 B2 US 11076894B2 US 201715631081 A US201715631081 A US 201715631081A US 11076894 B2 US11076894 B2 US 11076894B2
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pin
locator
fixing member
carrier
during use
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US20180368892A1 (en
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Thierry Marnay
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Stylitech
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Stylitech
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Priority to US15/631,081 priority Critical patent/US11076894B2/en
Priority to PCT/FR2018/000178 priority patent/WO2018234644A1/fr
Priority to EP18745998.7A priority patent/EP3641669B1/fr
Publication of US20180368892A1 publication Critical patent/US20180368892A1/en
Assigned to STYLITECH reassignment STYLITECH ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: MARNAY, THIERRY
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7077—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
    • A61B17/7079—Tools requiring anchors to be already mounted on an implanted longitudinal or transverse element, e.g. where said element guides the anchor motion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7082—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for driving, i.e. rotating, screws or screw parts specially adapted for spinal fixation, e.g. for driving polyaxial or tulip-headed screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/846—Nails or pins, i.e. anchors without movable parts, holding by friction only, with or without structured surface
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8897—Guide wires or guide pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass

Definitions

  • This invention relates to a system for inserting and removing a locator-pin in a bone, to a locator-pin, to an insertion pin-carrier and to a removal pin-carrier.
  • this invention concerns a system used for spinal surgery, in particular for installing screw-type implants for example, in order to stabilize tumor fractures, immobilize the spine in the case of arthrodesis (intervertebral grafting in order to fuse two or more vertebrae together) in degenerative diseases, and to correct deformations of the spinal column (scoliosis and kyphosis).
  • arthrodesis intervertebral grafting in order to fuse two or more vertebrae together
  • degenerative diseases deformations of the spinal column (scoliosis and kyphosis).
  • Pedicle screws are inserted into the vertebrae in very specific places, the pedicles, to allow deformations to be corrected without risking damage to the spinal column or its contents, the spinal cord. For this, precise mapping is required before insertion.
  • the “pedicle target” combines all aspects of difficulty: the most delicate or even impossible anatomical landmarks in the case of rotation of vertebral bodies, small pedicles and major risk of spinal cord injury in the event of cortical breach or following the wrong path.
  • the surgeon first opens up the patient and records his anatomical landmarks by identifying the entry points of the pedicles.
  • a “Trocar” comprising a rod with a trocar tip capable of penetrating the bone, and a cannula (or liner) consisting of a tube within which the rod slides.
  • the cannula and rod are provided with a handle for gripping.
  • This control is usually achieved with the aid of an image intensifier (fluoroscopy).
  • the surgeon removes the cannula, then inserts the pedicle screws down the hole, creating a tapped portion in the bone. If the latter is brittle or if there should be a slight twisting movement, the bone can crack or even rupture. Furthermore, the screw may not perfectly follow the hole previously made with the trocar.
  • the surgeon positions the curvature rods and reinforcement rods and fixes them in position.
  • the image intensifier is insufficient and gives rise to considerable radiation.
  • the anatomical points measured to readjust the images require long sequences of topographical measurements without achieving absolute precision, because the spine is an articulated system that is movable between each of its elements, and so likely to change its position albeit only as a result of respiratory movements.
  • O-Arm type scanners are also known, offering precise measurements that enable some of these drawbacks to be overcome, but their size, the time required to set them up, the difficulty of preparing the surgical site, taking scanner images and performing surgical procedures make their use very delicate and cumbersome. Moreover, the protection of personnel (surgeon, anesthetist, nursing staff and operation assistants) during the intervention complicates the repetitive use of this equipment when instrumentation is required along the full length of the spinal column. Asepsis problems also arise with this type of mapping on a patient undergoing open surgery.
  • the aim of the present invention is to propose an economical and very accurate device, enabling the implementation of an affordable, original and safe technical procedure that reduces exposure to surgery.
  • the invention enables markedly improved safety (improvement of the general asepsis of the operation and reduction of bleeding, neurological risk and operating complications), limitation to exposure to radiation, optimal positioning of implants including in regions not exploited until now, by combining mini-invasive surgery and interventional radiology by scanner.
  • the invention proposes to divide the operation into two separate phases: one in the radiology room, the other in the operating room.
  • the invention proposes a temporary-use locator pin, as well as a system for the insertion and removal of said locator-pin, to enable the passage between the phase in the radiology room and the operating phase in the operation room whilst improving the precision of positioning the pedicle screws thanks to optimum exchange of information between the radiologist and the surgeon.
  • the invention relates to a system for the insertion and removal of a locator pin for positioning a pedicle screw in a bone, the system comprising:
  • the invention also relates to a locator pin for positioning a pedicle screw in a bone, comprising:
  • the invention also relates to an insertion pin-carrier of a locator-pin described here above, the insertion pin-carrier comprising:
  • the invention also relates to an insertion pin-carrier of a locator-pin described here above, the insertion pin-carrier comprising:
  • the invention also relates to a removal pin-carrier of a locator-pin described here above, the removal pin-carrier comprising:
  • the invention also relates to a system for inserting and removing described here above, the system comprising:
  • the invention also relates to a method for inserting a locator pin for positioning a pedicle screw in a vertebrae of a patient, comprising:
  • the invention also relates to a method for recovering a positioned locator pin from a patient, comprising:
  • the invention also relates to a method for fixing a pedicle screw into the vertebra of a patient, comprising:
  • FIGS. 1 a to 1 d are schematic perspective views of a system for the insertion and removal of a so-called “locator” pin according to the invention comprising, in FIG. 1 a , a first embodiment of a locator-pin according to the invention, in FIG. 1 b , a first embodiment of an insertion pin-carrier according to the invention, in FIG. 1 c , a removal pin-carrier according to the invention and, in FIG. 1 d , a guide cannula;
  • FIG. 2 is a schematic perspective view of a second embodiment of a locator-pin according to the invention.
  • FIG. 3 is a schematic perspective view of a second embodiment of an insertion pin-carrier according to the invention.
  • FIGS. 4 to 8 are schematic sectional views of the method of implementing a system according to the invention to insert a locator-pin according to the invention before operation;
  • FIGS. 9 to 14 are schematic sectional views of the method of implementing the system according to the invention to remove a locator-pin according to the invention during the operation and to position a pedicle screw;
  • FIG. 15 is a schematic plan view of a cannulated pedicle screw.
  • FIG. 16 is a schematic plan view of the pedicle screw shown in FIG. 15 equipped with an extension tube.
  • FIG. 1 shows a system 100 for the insertion and removal of a locator pin 110 for positioning a pedicle screw in a bone.
  • the system 100 comprises a locator-pin 110 ( FIG. 1 a ), an insertion pin-carrier 120 ( FIG. 1 b ), a removal pin-carrier 130 ( FIG. 1 c ) and a guide cannula 140 ( FIG. 1 d ).
  • the locator-pin 110 comprises:
  • the two fixing members 118 and 119 are different, the insertion pin-carrier 120 is equipped with a fixing member 121 complementary to the first fixing member 118 of the locator-pin 110 , and the removal pin-carrier 130 is equipped with a fixing member 131 complementary to the second fixing member 119 of the locator-pin 110 .
  • the first fixing member 118 of the locator pin and the fixing member 121 of the insertion pin-carrier enable, basically, the rotatable connection of the insertion pin-carrier 120 to the locator-pin during the insertion of said locator-pin into the bone.
  • This insertion can be achieved by percussion, thanks to a hammer, but also by screwing the locator-pin into the bone.
  • the rotatable connection of the pin-carrier 120 to the locator-pin 110 enables a torque to be transmitted between the insertion pin-carrier 120 and the locator-pin 110 .
  • the first fixing member 118 of the locator pin and the fixing member 121 of the insertion pin-carrier also enable the dismantling of the insertion pin-carrier 120 and locator-pin 110 when the latter is in position in the bone.
  • the second fixing member 119 of the locator pin and the fixing member 131 of the removal pin-carrier enable, basically, the translational connection of the removal pin-carrier 130 to the locator-pin 110 during the removal of said locator-pin 110 from the bone. This removal must not damage the bone and, above all, the hole made during the insertion. The translational locking must therefore be firm and precise. Since the traction required to remove the locator-pin can be great, the second fixing member must be strong and must not risk being damaged on removal.
  • the first fixing member 118 is a radial locking member of the insertion pin-carrier 120 on the locator-pin 110
  • the second fixing member 119 is an axial locking member (i.e. parallel to the longitudinal direction of the slim body 112 of the locator-pin 110 ) of the removal pin-carrier 130 on the locator-pin 110 .
  • the first fixing member 118 is of the bayonet type and the second fixing member 119 is of the threaded type.
  • the first fixing member 118 comprises a lug arranged radially on the proximal portion 116 of the locator-pin and the fixing member 121 of the insertion pin-carrier comprises a groove located in the distal end of the insertion pin-carrier 120 .
  • the first fixing member 118 of the locator pin is designed to slide axially, during use, in the member 121 of the insertion pin-carrier.
  • the second fixing member 119 is a threaded portion arranged on the proximal portion 116 , between the first fixing member (lug) 118 (and a proximal end 116 a of the locator-pin 110 .
  • the second fixing member (threaded portion) 119 is designed:
  • the threaded portion 119 is protected from the hammer blows received by the insertion pin-carrier 120 .
  • it is screwed into the tapped hole 131 in order firmly and precisely to connect the removal pin-carrier 130 on the locator-pin 110 .
  • the numerous contact points between the threaded portion and the tapped portion ensure a precise positioning and a wide distribution of the traction forces, thus reducing the risk of damaging the second fixing member on removal.
  • the first fixing member 118 enables the insertion of the locator-pin by “screwing” into the bone.
  • a flat surface 115 is provided between the proximal part 116 and the pin body 112 . This flat surface 115 is arranged to be in contact with the distal end edge 124 of the insertion pin-carrier 120 .
  • the dimensions of the groove 121 and the cavity 122 are chosen so that the lug 118 is not in contact with the edges of the groove 121 and so that the proximal end of the locator-pin is not in contact with the bottom of the cavity 122 when the distal end edge 124 of the insertion pin-carrier 120 is in contact with the flat surface 115 .
  • the cylindrical body of the insertion pin-carrier 120 also comprises, at its proximal end, a gripping handle 126 .
  • the surgeon uses the removal pin-carrier 130 which comprises:
  • the system according to the invention comprises a guide cannula 140 designed to receive freely sliding the locator-pin 110 , the insertion pin-carrier 120 and the removal pin-carrier 130 .
  • the guide cannula 140 comprises an internal channel 141 running through the cannula 140 from one end to the other.
  • the cannula also comprises a gripping handle 142 , advantageously having a shape complementary to the handle 126 - 133 of the pin-carriers 120 - 130 to enable locking onto the cannula.
  • FIGS. 2 and 3 show a second embodiment of a locator-pin 210 and an insertion pin-carrier 220 according to the invention.
  • first fixing member 218 of the bayonet type comprises a groove arranged on the proximal portion 216 of the locator-pin 210
  • the fixing member 222 of the insertion pin-carrier comprises lug arranged radially in a cavity 224 located in the insertion pin-carrier 220 .
  • the insertion pin-carrier 220 of this second embodiment of the location pin thus comprises:
  • the second fixing member is also a threaded portion arranged on the proximal portion of the locator-pin, between the groove (the first fixing member) and the proximal end of the locator-pin.
  • the removal pin-carrier to remove the locator-pin according to this second embodiment is similar to that shown in FIG. 1 c.
  • FIGS. 4 to 14 show the method of implementation enabled by the system of locator-pins according to the invention.
  • the surgeon produces an implantation diagram of the pedicle screws, based on the scans of the spine in the coronal and sagittal plane, to be submitted to the radiology team.
  • the system according to the invention enables implants to be placed where previously it was impossible to do so (for example at the top of the concavity).
  • the surgeon can therefore define the locations of the screws so as to optimize the correction.
  • the determination of these locations obeys precise anatomical and biomechanical rules, although adjustment may be necessary in order to take into account the singularities of a patient.
  • the first step involves mapping the “key vertebrae” of the assembly: the apical vertebra and the most inclined vertebrae.
  • the choice of the bottom vertebra of the assembly is made by leaving, if possible, at least two or three free discs beneath the assembly.
  • the two extreme vertebrae must be on the same vertical plane seen from the front, the axis towards which the correction must aim.
  • the assembly must not stop at the thoraco-lumbar junction, the area of maximum stress between the fixed region and the region that remains mobile, but must on the contrary lock it by including at least vertebrae L1 or L2.
  • the surgeon then produces an implantation diagram for the radiologist who is to position the locator-pins 110 .
  • FIGS. 4 to 8 show the insertion of the locator-pin 110 .
  • vertebra O has a torsion of angle ⁇ between its X-X′ axis and the vertical V, a torsion that must be reduced until the angle ⁇ is substantially equal to 0.
  • the patient under general anesthetic is on the table of the scanner, which can be controlled by a joystick.
  • the radiologist locates on a full scan of the spine the pedicles to be instrumented and maps the corresponding cuts in order to locate directly the control position of the scanner during the procedure. He draws on the image the axis of the pedicle and checks the feasibility of installing implants.
  • the installation of locating pins by using a scanner imposes a certain number of essential conditions for the proper operation of the procedure.
  • the scanner room becomes an operating room like any operating procedure using a scanner.
  • Prior cleaning, as with any operating room, asepsis of the operating area, sterilization of the equipment and preparation of the radiology team for an operating procedure are essential.
  • Anesthesia for any surgical intervention begins here.
  • the equipment, fluids, respirator and anesthesia trolley, as well as the presence of an anesthetist, are essential throughout this procedure.
  • the operating radiologist positions the cannula 140 on the skin S of the patient ( FIG. 4 ). Then he inserts into the cannula 140 the locator-pin 110 - 210 fixed to the insertion pin-holder 120 by the first fixing member (arrows F 1 -F 2 ).
  • the operating radiologist then pierces the skin S of the patient with the trocar tip 114 of the locator-pin 110 - 210 and inserts the assembly up to the surface of the vertebrae O.
  • the operating radiologist inserts the locator-pin into the axis of the pedicle to around 10 mm to ensure passage through the hard outer surface, formed of compact bone, called the cortical layer.
  • the operating radiologist can use, instead of the locator-pin/insertion pin-carrier, a simple Jamshidi-type trocar rod with a Jamshidi-type cannula 140 .
  • he must then remove the trocar needle, leaving in place the cannula 140 that surrounds it and serves as a target guide to install the locator-pin/insertion pin-carrier assembly.
  • the locator-pin 110 - 210 fixed to the pin-carrier 120 - 220 by the first fixing member 118 and slid into the cannula 140 , is then driven into the axis of the pedicle of each vertebra O to be instrumented (and as far as possible parallel to the vertebral endplate) with a hammer or with the aid of a micromotor, depending on the mapping performed and checked by a scanner in real time (arrows F 3 -F 4 ; FIG. 5 ).
  • the first fixing member 118 is disengaged in order to remove the insertion pin-carrier 120 and the cannula 140 .
  • this is done by performing a rotation/translation movement on the handle (arrows F 5 -F 6 ) if the groove 121 is L-shaped, or by a simple translation movement if the groove is straight and serves only to prevent rotation between the insertion pin-carrier 120 and the locator-pin 110 .
  • the length of the locator-pins 110 - 210 installed is chosen so that the threaded end is just under the skin and can be palpated for easy localization ( FIG. 8 ).
  • the patient is taken to the operating room, accompanied by a transmission log completed by the radiologist and given to the surgeon.
  • This log comprises a report on the intervention, indicating any anomalies, as well as a series of scanner images showing all of the instrumented vertebrae in axial view, plus a general front and profile view. This enables the surgeon to compare the actual implantation of the locator-pins with his intervention diagram and ensure that the operating procedures are feasible.
  • FIGS. 9 to 14 show the operating phase of installing pedicle screws and corrective rods.
  • the patient is installed on the operating table in a prone position, with no external stress: in particular, no traction.
  • the aim is to effect the correction from a position that is “natural” or relaxed and above all not pre-stressed.
  • the patient is accompanied by his “transmission log,” together with scanner slices and general views to enable the positioning to be checked. This log takes the place of documentation for the file.
  • the intervention is mini-invasive because the incisions can be limited to the minimum necessary to disengage the heads of the locator-pins 110 .
  • the first surgical procedure is to recover the locator-pins 110 while of course preserving the “pedicle's ballistic path” in order to insert cannulated pedicle screws.
  • the insertion point of the locator-pins 110 is located visually and by palpation.
  • the surgeon makes a 16- to 18-mm incision to disengage the head.
  • the incision is made opposite the subcutaneous projection of the pin of which the initial penetration hole is also visible on the skin (see FIG. 8 ).
  • the incision can be single or elongated for two contiguous locator-pins 110 .
  • the superficial end of the locator-pin 110 having thus been identified, the cannula 140 is reinserted (arrow F 7 ; FIG. 9 ) encasing the locator-pin and following its path into the pedicle of vertebra O.
  • a removal pin-carrier 130 is then introduced into the cannula 140 (arrow F 8 ; FIG. 9 ) and screwed onto the threaded end of the locator-pin 110 (arrow F 9 ; FIG. 10 ).
  • the locator-pin 110 is removed through the hole in the cannula 140 , which is left in place.
  • a flexible guide-rod 150 (Kirschner wire) is slid into the cannula 140 ( FIG. 11 ), which is then carefully removed.
  • the locator-pins 110 are replaced by guide-rods that ensure a perfect pedicle target. A guide to insert the pedicle screws is then in place along the path created in the pedicle by the locator-pins 110 installed when mapping by radiology using a scanner.
  • a first dilator tube 160 is placed around the guide-rod 150 until contact is made with the pedicle ( FIG. 12 ).
  • the dilator tube consists of several coaxial tubes of increasing diameters.
  • a first small-diameter tube is inserted round the guide-rod, then a second larger-diameter tube, around the first, then a third even larger-diameter tube around the second.
  • the pedicle screw 170 On insertion and reduction of the torsion, the pedicle screw 170 is fixed to the end of a tubular extension 172 ( FIG. 16 ).
  • a cannulated square tip guided by the dilator tube can be used.
  • a starter hole can advantageously be tapped to facilitate the passage of the screw 170 .
  • the pedicle screw 170 Fixed to the end of a tubular extension 172 , the pedicle screw 170 is guided by the guide-rod 150 to the starter hole into which it is screwed to the desired depth.
  • the guide-rod 150 can be removed as soon as the screw is properly engaged in the pedicle.
  • the extension tubes can be left in place to act as handles that will enable the position of the vertebrae to be adjusted, as shown in FIG. 14 .
  • the surgeon reduces the torsion of the vertebra either by hand or with the aid of a dedicated tool until the axis X-X′ of the vertebra is vertical, in the case shown.
  • the vertebra is thus held in place thanks to a correction rod 180 .
  • this straightening operation is performed in several steps.
  • the most inclined vertebrae are rendered horizontal thanks to an angle correction device (for example Marnay's Angle Corrector): this type of device, used in the case of extreme curvatures that are difficult to reduce, enables, thanks to a double rack on the concave side and on the convex side, the overall curvature between the two most inclined vertebrae to be corrected and to maintain this correction until rods are installed.
  • an angle correction device for example Marnay's Angle Corrector
  • vertebral distraction is performed in the case of pronounced narrowing.
  • the action of the distractor compared to that of the horizontalizer, is local and lateral, at the segmental level. It enables significant narrowing between two consecutive vertebrae to be corrected.
  • the correction rods curvature rods and reinforcement rods, are positioned.
  • Titanium curvature rods are relatively flexible in order to facilitate their insertion and obtain a first reduction of scoliosis without excessive stress.
  • Chrome-cobalt reinforcement rods are more rigid than the correction rods that they complement and fix the corrective effect.
  • All correction rods must be bent so as to anticipate the target sagittal curvature (dorsal lordosis) whilst matching as closely as possible the frontal curvature to be corrected.
  • the relative flexibility of a titanium rod enables its curvature to be increased, at the same time the reduction of the vertebral curvature is begun, in order to marry it up with the heads of the pedicle screws.
  • the rods are installed as described below.
  • the first rod to be installed is the curvature rod on the concavity side. Before being inserted, this rod must be bent so as to anticipate the target sagittal curve (kyphosis and dorsal lordosis) while matching up as closely as possible with the frontal curvature to be corrected; it is also cut to the correct length.
  • target sagittal curve kyphosis and dorsal lordosis
  • the concave curvature rod is introduced percutaneously, from the top downwards (in the craniocaudal direction), by manipulating the extension tubes to place the tulip of the screw head opposite the end of the rod.
  • the rod may be preferable to insert the rod from the bottom upwards, i.e. by starting from the pelvis, which is the natural reference point. But lumbar lordosis and the buttocks are a hindrance to introducing the rod, whereas the head, being narrower and inclined forwards, is much less so.
  • the lock nut When the rod is inserted into the pedicle screw head, the lock nut is fitted but not tightened up: it is in fact essential to maintain maximum freedom in the adjustment of the position of the vertebrae until the end of the intervention so as to optimize the correction.
  • the convex curvature rod is then introduced just after the concave curvature rod; it will serve as a counter-brace facilitating the maneuvers of “derotation” and horizontalization of the vertebrae.
  • the concave curvature rod is pivoted 90° about its main axis which, together with an action on the extension tubes, forces the derotation and horizontalization of the vertebrae.
  • the concave curvature rod Once the concave curvature rod has been turned 90°, it can be fixed by tightening the nut on the pedicle screw head of the top vertebra of the assembly. No other screw head will be tightened at this stage in order to allow the rod to slide without further stress until the reduction of the curvature has been completed.
  • the convex curvature rod After the concave curvature rod has been turned 90°, the convex curvature rod is turned 90° in its turn and in the same way, which perfects the correction.
  • the rod further reduces the vertebral curvature. Then the 90° rotation of the rod further reduces the curvature, which is completed by installing the convex rod.
  • the rod If the return force of the rod is less than that of the spine, the rod only partially restores the curvature of the spine. And even after the 90° rotation, the rod stays curved in the frontal plane. In these conditions, the convex rod also does not succeed in reducing the curvature of the spine. Reinforcement rods are therefore required.
  • the first reinforcement rod is located on the concavity side to fix the preliminary reduction ensured by the correction rod.
  • the second reinforcement rod located on the convexity side, serves to maintain a rotation torque that corrects the gibbosity.
  • the correction can be adjusted before the nuts are gradually tightened.
  • a bone graft was absolutely essential in the conventional state of the art (as was fitting a Harrington rod) in order for vertebral fusion to compensate for the considerable stress exerted on the assembly.
  • grafts are then injected: bank bone or bone substitute (hydroxyapatite), plus bone marrow.
  • the precision of implantation of the locator-pins almost totally reduces the risk of following the wrong path and intruding into the medullar canal.
  • the system according to the invention enables the operation to be divided in two: one phase in the radiology room and one phase in the operating room.
  • the procedure enabled by the system according to the invention is very advantageous since the scanner it uses in the radiology room is the same as those that exist in any hospital, a scanner whose use is not reserved solely for this purpose and which can therefore operate continuously for very diverse applications.
  • the duration of the “overall” intervention is more or less equivalent to that of a traditional technique, the time spent in the operating theater is reduced by half. Considering that two people are required in radiology and four or five in theater, making a total intervention time of 6 hours, the saving is 6 to 9 h of personnel time.
  • the invention includes the following non-limiting embodiments. These embodiments are provided as examples only and do not limit the scope of the invention.
  • a locator pin ( 110 - 210 ) for positioning a pedicle screw in a bone comprising:
  • the locator pin ( 110 - 210 ) according to embodiment 2, wherein the first fixing member ( 118 ) is a radial locking member (of the insertion pin-carrier ( 120 ) on the locator-pin ( 110 ), and the second fixing member ( 119 ) is an axial locking member, parallel to the locator-pin, of the removal pin-carrier ( 130 ) on the locator-pin ( 110 ).
  • the locator pin ( 110 - 210 ) according to any of embodiments 2 to 6, wherein a flat surface ( 115 ) is provided between the proximal part and the pin body.
  • An insertion pin-carrier ( 120 ) of a locator pin comprising:
  • An insertion pin-carrier ( 220 ) of a locator-pin ( 210 ) comprising:
  • a removal pin-carrier of a locator-pin ( 110 - 210 ) comprising:
  • a system for inserting and removing according to embodiment 1, comprising:
  • a method for inserting a locator pin for positioning a pedicle screw in a vertebrae of a patient comprising:
  • a method for recovering a positioned locator pin from a patient comprising:
  • a method for fixing a pedicle screw into the vertebra of a patient comprising:

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  • Health & Medical Sciences (AREA)
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US15/631,081 2017-06-23 2017-06-23 System for inserting and removing a locator-pin in a bone Active US11076894B2 (en)

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Application Number Priority Date Filing Date Title
US15/631,081 US11076894B2 (en) 2017-06-23 2017-06-23 System for inserting and removing a locator-pin in a bone
PCT/FR2018/000178 WO2018234644A1 (fr) 2017-06-23 2018-06-22 Systeme d'insertion et de retrait d'une broche repere dans un os
EP18745998.7A EP3641669B1 (fr) 2017-06-23 2018-06-22 Système d'insertion et de retrait d'une broche repère dans un os

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FR1770666A FR3067923B1 (fr) 2017-06-23 2017-06-23 Systeme d’insertion et de retrait d’une broche repere dans un os.
US15/631,081 US11076894B2 (en) 2017-06-23 2017-06-23 System for inserting and removing a locator-pin in a bone

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US10973558B2 (en) 2017-06-12 2021-04-13 K2M, Inc. Screw insertion instrument and methods of use
CN111640345A (zh) * 2020-05-22 2020-09-08 北京数医脊微科技有限公司 脊柱内镜穿刺置管训练方法、装置及计算机设备
US11596452B2 (en) 2021-02-02 2023-03-07 Medos International Sarl Surgical instruments and methods for selectively coupling to an object

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US5196015A (en) 1992-04-30 1993-03-23 Neubardt Seth L Procedure for spinal pedicle screw insertion
US5456267A (en) * 1994-03-18 1995-10-10 Stark; John G. Bone marrow harvesting systems and methods and bone biopsy systems and methods
US5954671A (en) * 1998-04-20 1999-09-21 O'neill; Michael J. Bone harvesting method and apparatus
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US20070270896A1 (en) 2006-04-21 2007-11-22 Mi4Spine, Llc Pedicle access device
US20070276402A1 (en) * 2003-11-19 2007-11-29 Frankel Bruce M Fenestrated bone tap and method
US20100168751A1 (en) 2002-03-19 2010-07-01 Anderson D Greg Method, Implant & Instruments for Percutaneous Expansion of the Spinal Canal
US20130012999A1 (en) * 2009-12-28 2013-01-10 Safe Orthopaedics Device and method for spinal surgery

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Publication number Priority date Publication date Assignee Title
US3719186A (en) * 1971-04-22 1973-03-06 Univ Alabama In Birmingham Surgical instrument for placement of bone pins and holes therefor
US5196015A (en) 1992-04-30 1993-03-23 Neubardt Seth L Procedure for spinal pedicle screw insertion
US5456267A (en) * 1994-03-18 1995-10-10 Stark; John G. Bone marrow harvesting systems and methods and bone biopsy systems and methods
US5954671A (en) * 1998-04-20 1999-09-21 O'neill; Michael J. Bone harvesting method and apparatus
US6719758B2 (en) * 2001-01-19 2004-04-13 Aesculap Ag & Co. Kg Kirschner wire with a holding device for surgical procedures
US20100168751A1 (en) 2002-03-19 2010-07-01 Anderson D Greg Method, Implant & Instruments for Percutaneous Expansion of the Spinal Canal
US20070276402A1 (en) * 2003-11-19 2007-11-29 Frankel Bruce M Fenestrated bone tap and method
US20070270896A1 (en) 2006-04-21 2007-11-22 Mi4Spine, Llc Pedicle access device
US20130012999A1 (en) * 2009-12-28 2013-01-10 Safe Orthopaedics Device and method for spinal surgery

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EP3641669A1 (fr) 2020-04-29
FR3067923A1 (fr) 2018-12-28
EP3641669B1 (fr) 2021-05-26
US20180368892A1 (en) 2018-12-27
WO2018234644A1 (fr) 2018-12-27
FR3067923B1 (fr) 2019-08-23

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